Provider Demographics
NPI:1700631033
Name:MID VALLEY GOLDEN CARE LLC
Entity Type:Organization
Organization Name:MID VALLEY GOLDEN CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SEGURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-474-7300
Mailing Address - Street 1:5601 W PARR AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-2658
Mailing Address - Country:US
Mailing Address - Phone:559-474-7300
Mailing Address - Fax:
Practice Address - Street 1:4733 W SPRUCE AVE STE 115
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-3576
Practice Address - Country:US
Practice Address - Phone:559-474-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-19
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care